Treatments

There are a number of different treatment options available for mCRC. It is important to note that not everyone will receive the same combination of treatments, but should instead have a personalised treatment plan, tailored to their individual needs.

Tragically, not all patients receive a personalised treatment plan as there is great variation in the quality and availability of treatment and care between and within countries. Get Personal is committed to eliminating this unacceptable variation so that everyone, irrespective of where they live, has access to the best treatment and care

For more information on treatment of mCRC in your country please select from the links below:

Once a physician has received the diagnostic test results and can fully understand the extent of the cancer, he or she may recommend surgically removing as much of the tumour(s) as possible, to help with the treatment process.

Surgery is not suitable for all mCRC patients, and depends on tumour size and location, as well as how advanced the cancer is.

Chemotherapy is the use of ‘anti-cancer’ (also known as cytotoxic) drugs to destroy cancer cells in the body. Patients may have chemotherapy to treat bowel cancer, either alone or together with other treatments.

The chemotherapy drugs can be given in different ways:

Oral chemotherapy: some chemotherapy drugs are available as a tablet to be swallowed, and can be taken at home.

Intravenous (IV) injection: the treatment is injected into a vein. There is a wide range of schedules for chemotherapy which can vary from a small injection over a few minutes, a short infusion of up to 30 minutes, or longer infusions over the course of a couple of hours or even days.

Each chemotherapy drug or combination has its own side effects. Common side effects include:

Loose bowel movements (diarrhoea)

Increased risk of infection

Sore mouth

Feeling and being sick

Neuropathy

Chemotherapy can also cause temporary or permanent infertility, depending on the drugs and doses used.

Some chemotherapy can damage the nerves in people’s hands and/or feet. This is called neuropathy. Symptoms usually improve a few weeks or months after treatment ends but they may get worse before they get better. Some people have long-term problems with nerve pain.

Radiotherapy is the use of controlled, high-energy radiation, usually X-rays, to destroy cancerous tumours. Radiotherapy can be given on its own or combined with chemotherapy – known as ‘chemoradiotherapy’. Radiotherapy can be given in two ways:

External radiotherapy is delivered from outside of the body by a machine and takes only a few minutes. The intention is to avoid subjecting healthy tissue to radiation and also to minimise the side effects that would otherwise occur if all the radiation was delivered all at one time. During each treatment session, a ‘fraction’ of the radiation is given, which will equal the full dose by the end of the course.

Internal radiotherapy involves positioning radioactive sources inside or near to the tumour. The main advantage of this treatment is that it can deliver a high dose of radiation directly to the cancer while limiting potential damage to surrounding tissues and organs. This treatment – also known as brachytherapy or contact radiotherapy – is not currently available at all cancer centres.

Radiotherapy can be used at several different stages of treatment:

Preoperative radiotherapy: (also known as neo-adjuvant radiotherapy) can be given before surgery:

To shrink the tumour to make it easier to remove

To reduce the risk of the cancer coming back (‘recurrence’) after surgery.

Postoperative radiotherapy: (also known as adjuvant radiotherapy) can be given after surgery:

To destroy any cancer cells that may be left behind

If the tumour was difficult to remove

If the cancer has grown through the wall of the rectum or spread to nearby lymph nodes.

Palliative radiotherapy: lower doses of radiotherapy, over a shorter period of time, can also be given if surgery is not an option, in order to:

Relieve symptoms

Slow the spread of the cancer

SIRT (also called radioembolisation): is a targeted treatment which involves millions of very tiny 'beads' (micro-spheres) being injected into the liver. Each bead, which is about one third the diameter of a human hair, is coated with a radioactive substance that gives out radiation specifically to the liver (concentrating mainly in the tumours).

Scientists now understand that colorectal cancer starts when the genes (or ‘blueprint’) of individual cells in the bowel are damaged or changed in some way. Knowing the genetic type of the cancer can help an oncologist select the most effective treatment for each patient. This may also avoid physicians or doctors giving their patients treatments that are unlikely to work.

Treatment with the most appropriate precision medicines may depend on the results of specific genetic tests – called biomarker tests – on the tumour tissue.

Biomarkers, short for biological markers, are biological molecules found in blood, other body fluids or tissues that may be measured to provide information about a tumour. Once biomarker testing is done, results of a biomarker test may:

Indicate normal or abnormal cell function;

Provide insight on the likely outcome from the cancer if it is left untreated (i.e. prognosis);

Predict the likelihood of the cancer’s response to a specific treatment plan or lack of response to a treatment plan; and/or

Help you and your doctor make decisions about care.

The most common biomarker tests include:

RAS testing

One type of genetic testing is known as a ‘RAS’ test: this uses a sample of tissue from the cancer to find out if it has a particular genetic ‘signature’. This test will indicate whether the tumour has either a normal RAS gene – known as ‘wild-type RAS’ – or a ‘mutated RAS’ gene.

Overall survival rates for mCRC patients have been shown to be extended when they are given treatments optimised for their specific RAS status, so it is crucial that all patients with mCRC receive a RAS test before starting treatment.

IHC (ImmunoHistoChemistry) testing

Immunohistochemistry (IHC) testing is performed to analyse colon and other tumour tissue samples for features suggestive of Lynch syndrome/hereditary non-polyposis colorectal cancer (HNPCC).

PIK3CA testing

12-32% of patients with mCRC have PIK3CA mutant tumours. Patients with mCRC having PIK3CA non-mutant tumours have been shown to have better survival as compared with patients with mutated PIK3CA.

BRAF testing9-10% of patients with mCRC have BRAF mutant tumours. Patients with mCRC having BRAF non-mutant tumours have been shown to have better survival as compared with patients with mutated BRAF.

Precision medicines

The development of precision medicine – also known as personalised or targeted therapies – is an exciting step in the treatment of mCRC, as it may make it possible to destroy cancer cells without damaging other, healthy cells. This is a relatively new field of research and many of the therapies are still experimental. These therapies may:

Stop cancer cells from dividing and growing

Seek out cancer cells and kill them

Encourage the immune system to attack cancer cells

Affect the growth of blood vessels into the tumour.

There are a number of biological therapies available to treat colorectal cancer, these include:

Bevacizumab (Avastin)

Cetuximab (Erbitux)

Panitumumab (Vectibix)

Ramucirumab (Cyramza)

Regorafenib (Stivarga)

Ziv-aflibercept (Zaltrap)

Trifluridine and tipiracil (Lonsurf)

Pembrolizumab (Keytruda)

For more information on treatment of mCRC in your country please select from the links below: